-ASH Kit Request Form

Is this your first request for any -ASH Kit (including D.A.S.H., Flash, or Slash kits) from ISTG?

If the answer is no, we're sorry but we are only able to do one kit per person with our current resources. Please do not submit another request. It will not be filled.

Yes

-ASH Kit Requested

These kits are for very specific communities. Please only request a kit if you are in the following communities. We recognize you may qualify for more than one kit, but we are only able to send one per person. Please choose the one that best fits your needs.

D.A.S.H. Kits - survivors of domestic violence
Flash Kits - folks going through menopause and homelessness
Slash Kits - non-cis folx who cannot afford or safely access products

First Name

Last Name

Email

Phone number

Is this request for you?

Yes
No - it is for a family member or friend
No - I am from an organization requesting for a program participant
No

Name for the box (if different than your name)

Street Address

Please give the number and street name.

City

State

Zip Code

Country

We cannot ship internationally at this point.

United States

Please mark all items you would use if included in your kit (pending availability):

How have you been managing your period, if you have one?

If you do not have a period, please type N/A

{name}

What services have you used in the last year? Mark all that apply.

Please share a little about your journey, and why these products will be helpful to you.

{name}

Are there any other products that would help you on your journey?

{name}

Is there anything else you would like to share?

{name}

Where did you hear about us?

May we check in with you in the future?

Yes
No

I understand that ISTG may use parts of my story to raise more awareness around this issue. All identifying information will be removed, and names will be changed.

Alert